BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INSET GUARD

    MDR report key: 24712379 · Received March 30, 2026

    Report

    Report Number
    8021545-2026-99852
    Event Type
    Malfunction
    Date Received
    March 30, 2026
    Date of Event
    December 13, 2023
    Report Date
    February 25, 2026
    Manufacturer
    UNOMEDICAL A/S
    Product Code
    FPA
    UDI-DI
    05705244022805
    PMA / PMN Number
    K210544
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    UNOMEDICAL HEREBY SUBMITS THIS INITIAL REPORT AS PART OF ITS COMPLAINT REMEDIATION ACTIVITIES CONDUCTED UNDER A CAPA/FDA ACTION PLAN. THIS SUBMISSION INCLUDES A RETROSPECTIVE REASSESSMENT OF PREVIOUSLY EVALUATED COMPLAINTS. UNOMEDICAL IS PROVIDING THIS INITIAL INFORMATION IN ACCORDANCE WITH THE REPORTING REQUIREMENTS SET FORTH IN 21 CFR PART 803. ANY FIELDS LEFT BLANK INDICATE THAT THE INFORMATION IS UNKNOWN, UNAVAILABLE, OR REMAINS UNCHANGED. BASED ON THE REVIEW COMPLETED ON 25-FEB-2026 AND INVESTIGATION COMPLETED ON 13-MAR-2026 THIS MEDICAL DEVICE REPORT (MDR) IS BEING SUBMITTED AS THE INITIAL REPORT. ADDITIONAL INFORMATION - THIS MDR IS BEING SUBMITTED TO INCLUDE THE BELOW: H6: INVESTIGATION RESULTS UNDER TYPE OF INVESTIGATION, INVESTIGATION FINDINGS, INVESTIGATION CONCLUSIONS. H11: INVESTIGATION SUMMARY. COMPLAINT INVESTIGATION RESULTS: REVIEW OF COMPLAINT RECORD DATA BASE 1800377 EVENT DESCRIPTION AND ALL AVAILABLE INFORMATION WAS COMPLETED, AND LOT NUMBER 6003072 WAS PROVIDED. COMPLAINT WAS CLASSIFIED UNDER MALFUNCTION CODE: LEAK BETWEEN TUBING AND SITE CONNECTOR - DETACHMENT / SIGNIFICANT WETNESS. A QUERY WAS RUN IN THE EQMS ON 13-MAR-2026 AGAINST "LOT NUMBER" "6003072" AND SIMILAR MALFUNCTION CODE(S). LEAK BETWEEN TUBING AND SITE CONNECTOR - DETACHMENT / SIGNIFICANT WETNESS LEAK BETWEEN TUBING AND SITE CONNECTOR Â - DETACHMENT / SIGNIFICANT WETNESS LEAKAGE FROM CONNECTION BETWEEN THE TUBING CONNECTOR AND THE INFUSION SET (CANNULA PART/BASE PIECE). LEAKAGE FROM CONNECTION BETWEEN THE TUBING CONNECTOR AND THE INFUSION SET (CANNULA PART/BASE PIECE) (SPECIFIC CAUSE IDENTIFIED). TUBING DETACHED FROM TUBING CONNECTOR. TUBING DETACHED FROM TUBING CONNECTOR. TUBING CONNECTOR IS CRACKED, SPLIT, DEFORMED, LEAKAGE MAY OCCUR. TUBING CONNECTOR IS CRACKED, SPLIT, DEFORMED, LEAKAGE MAY OCCUR. NO RECORDS WERE IDENTIFIED FOR THIS LOT AND SIMILAR RELATED ISSUES. A NON-CONFORMANCE NC/ CORRECTIVE AND PREVENTIVE ACTION (CAPA) QUERY SEARCH WAS RUN IN THE ELECTRONIC QUALITY MANAGEMENT SYSTEM (EQMS) SYSTEM PERFORMED ON 13-MAR-2026 AGAINST "LOT/BATCH NUMBER" "6003072". NO RECORDS WERE FOUND. DHR REVIEW: THE DEVICE HISTORY RECORD (DHR) FOR LOT 6003072 WAS REVIEWED. REVIEW OF THE DHR SHOWED THAT ALL RELEVANT TESTS REQUIRED DURING THE RELATED PROCESSES HAD BEEN FULFILLED AND MET THE REQUIREMENTS. NO DEVIATION WAS IDENTIFIED, NOR MAINTENANCE EVENTS WERE RECORDED RELATED TO COMPLAINT CODE. CONCLUSION OF COMPLAINT INVESTIGATION: LOT NO. 6003072 WAS PROVIDED, HOWEVER, AS THE COMPLAINT IS CATEGORIZED AS A REPORTABLE WITH NO HARM REPORTED AND NO ISSUES WERE FOUND DURING EQMS SEARCH AND DHR REVIEW: ·NO VISUAL INSPECTION IS REQUIRED TO BE PERFORMED. ·NO RETAIN SAMPLE TESTING IS REQUIRED TO BE CONDUCTED. ·NO FURTHER ASSESSMENT WILL BE MADE REGARDING POTENTIAL PRODUCT PERFORMANCE ISSUES, COMPONENT INTEGRITY, OR MANUFACTURING DEFECTS. CAPA DETERMINATION: BASED ON THE AVAILABLE INFORMATION, NO FURTHER INVESTIGATION IS REQUIRED NOR CAPA PLAN IS NEEDED. THE RECORD WILL BE CLOSED AND MONITORED THROUGH TRACKING AND TRENDING (MONTHLY TRIPS AND ALERTS). SUMMARY CONCLUSION: BASED ON THE AVAILABLE INFORMATION, THE INVESTIGATION HAS BEEN PERFORMED, AND THE COMPLAINT COULD NOT BE CONFIRMED AS ANALYZED. THEREFORE, THE COMPLAINT IS CLOSED BASED ON THE EVENT DESCRIPTION AND ALL INFORMATION MADE AVAILABLE.

    Description of Event or Problem · 0

    REFERENCE NUMBER (B)(4). EVENT OCCURRED IN THE UNITED STATES. IT WAS REPORTED THAT PATIENT FACED INFUSION SET DETACHMENT EVENT ON (B)(6) 2023. THE INFUSION SET WAS DETACHED FROM THE BODY. NO FURTHER INFORMATION AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    776429 INSET GUARD UNO EWIS BLUE 60/9 HCAP 10PK INT FPA UNOMEDICAL A/S MMT-441A 6003072 05705244022805

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown